Obamacare a success so far? It's hard to say

ST. PAUL, Minn. – After more than a week in action, is a key feature of President Barack Obama's health care overhaul a success or a bust? Judging by the dearth of data, it's virtually impossible to say.

The federal government has released no comprehensive data on how many people have enrolled for health insurance using federally run exchanges, the online marketplaces being used in 36 states for residents to compare and buy insurance. In the 14 states running their own exchanges, the situation isn't much better.

Officials with California's exchange say it will be mid-November until they can say how many people signed up. In Oregon and Colorado, the official number of completed applications is zero. And in Minnesota, which billed itself as a leader in implementing the Affordable Care Act, officials won't release data until next week about the number of applications started and completed.

As a result, a nation obsessed with keeping score to determine winners and losers is finding it difficult to pass immediate judgment on a law that will in large part define the president's legacy.

"Obamacare has a lot of cynics in this country, and it needs to get off to a better start than what we see so far if it's going to be a success," said Bob Laszewski, a Washington, D.C.-based health care industry consultant.

MNsure, Minnesota's online insurance marketplace, reported 9,200 accounts had been initiated as of Thursday, said April Todd-Malmlov, the exchange's director. But enrollment figures won't be available until Wednesday. She said some users inadvertently submitted multiple applications that need to be consolidated.

Similar problems abound. Many states running their own exchanges haven't released initial enrollment data, and only a handful are providing a detailed picture of applicants and the plans they are choosing.

Oregon, another state that embraced the law, hasn't even opened enrollment because its software can't determine eligibility for Medicaid or for tax credits that help pay for insurance. Vermont's system is so buggy that officials are issuing paper applications, even though the thinly populated state received $171 million – among the largest amounts in federal grants – to run its exchange and upgrade technology.

The U.S. Department of Health and Human Services, which is overseeing the federally run exchanges, doesn't expect to release enrollment data until mid-November. But scattered reports from those states aren't encouraging. For example, Delaware had yet to confirm a single enrollment by Thursday, and many Florida groups designated to help people sign up say they still can't complete the enrollment process online.

The Obama administration has worked feverishly to fix the website delays, frozen screens and other glitches that they attributed to the high level of consumer interest, not software or design issues. But independent experts said it's probably a combination of all those factors, noting that a high volume of users tends to expose software issues undetected by testing.

The federal exchanges, for instance, require users to create accounts before they can browse for insurance plans, adding to website volume. Most e-commerce sites, and several state-run health insurance marketplaces, allow consumers to window shop without an account. An HHS spokeswoman said the agency required consumer accounts so people would know whether they were eligible for subsidies before shopping.

Data is coming from insurance companies in some states, though it largely shows only a trickle of enrollment. Those include Vantage Health Plan, one of four companies offering plans through Louisiana's exchange that reported enrolling 12 people, and CoOportunity Health, which reported five enrollees in Iowa and nine in Nebraska as of mid-week.

"I am very worried that people will lose faith in the system," said John Foley, an attorney helping Florida residents navigate the system. "Clearly we are losing most if not all of the momentum that was built up leading to open enrollment."

One major exception is Kentucky, where 18,351 people had enrolled by Wednesday. Despite relentless criticism from Kentucky Republican Sens. Mitch McConnell and Rand Paul, Democratic Gov. Steve Beshear has been an enthusiastic adopter of the Affordable Care Act. He believes providing medical coverage can only benefit a state that ranks among the worst in nearly every health measure.

"These people are our friends and neighbors," Beshear said. "They roll the dice and pray they don't get sick."

Kentucky is among the few states that have released information about enrollees, such as their age, family size or employment status. Also largely unknown is what types of coverage are being purchased: lower-end plans with affordable premiums but high deductibles, or more expensive plans with lower deductibles?

A few other state-run exchanges have reported early activity, with the leader being New York, where 40,000 applicants processed by Wednesday. In California, the nation's most populous state, 16,300 applications had been completed by Tuesday — but that was less than in Kentucky, a state with one-tenth the number of uninsured people than California.

But industry insiders say the enrollment system is starting to work more smoothly.

"Going into this, (insurers) were expecting to see some challenges," said Karen Ignagni, head of America's Health Insurance Plans, according to the insurance industry's primary lobbying group. "What people are pleased about is they are seeing progress. ... They would be more worried right now if they were not seeing progress."